Markets at Risk— Current and Future Challenges in a Managed Care Marketplace. C. Consumer acceptance.


Plans know well what their marketing executives have been telling them—choice sells. The proliferation of broad network, open access, less intrusive UM all underscore this. The plaudits United Healthcare received when they announced the abandonment of pre-service authorization exceeded their own expectations in terms of a public relations coup. On another front, some of the softening of support for capitation also reflects discomfort and restiveness that consumers have felt toward the possibility of their physicians might have financial incentives to withhold care73. The many, many consumer protections passed primarily by state legislatures in the past several years to ease access to certain specialists, guarantee availability of POS products, force plans to contract with any willing providers all further illustrate efforts to break down real and perceived barriers to access74. All of these impositions, in effect, appear to be converting the HMO to a PPO type of product that has been demonstrated to garner a higher degree of consumer acceptance. Accompanying this acceptance will be additional offloading of costs to consumers which employers will try to modulate as long as the labor market remains so tight.

  1. J. Goldsmith, Keynote Address, Academy for Health Services Research Annual Meeting, Los Angeles, June 26, 2000.
  2. C. Havighurst, “Vicarious Liability: Relocating Responsibility for the Quality of Medical Care,” American Journal of Law & Medicine, 26:7-29, 2000.